1H-MRS观察帕金森病患者延髓及黑质代谢

~1H-MRS in observation of metabolism of medulla oblongata and substantia nigra in Parkinson disease

目的采用1H-MRS分析帕金森病(PD)患者延髓及患侧黑质中主要代谢物的改变及其与临床病情的关系。方法 选取PD患者17例(PD组),正常对照17名(正常对照组)。采用Philips1.5T磁共振成像系统单体素1H-MRS技术,选取延髓及患侧黑质作为感兴趣区进行MRS扫描,获取N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)峰下面积,计算NAA/Cr、Cho/Cr比值。结果 PD组延髓和患侧黑质与正常对照组比较,NAA/Cr、Cho/Cr比值差异均无统计学意义。PD患者延髓NAA/Cr、Cho/Cr比值与临床指标未发现显著相关性。PD患者患侧黑质NAA/Cr比值与UPDRS评分(r=-0.686,P=0.007)及UPDRS运动评分(r=-0.724,P=0.004)显著负相关;Cho/Cr比值与UPDRS评分(r=-0.770,P=0.002)及UPDRS运动评分(r=-0.843,P<0.001)呈显著负相关。患侧黑质处NAA/Cr、Cho/Cr与H&Y分级呈显著负相关(r=-0.697、-0.715,P=0.012、0.009)。结论 采用1H-MRS检测延髓及患侧黑质NAA、Cho尚不能作为诊断PD的手段。检测患侧黑质代谢物改变能够反映患PD者病情进展情况。

Objective To investigate the metabolic changes in medulla oblongata and unilateral substantia nigra of Parkinson＇s disease with 1H-magnetic resonance spectroscopy（1H-MRS）,and to observe their correlation with clinical conditions of Parkinson disease（PD） patients.Methods Totally 17 PD patients（PD group） and 17 healthy subjectd（control group） were enrolled.Philips 1.5T MRI scanner was used.The medulla oblongata（MO） and the unilateral substantia nigra（SN） were selected as ROI.N-acetyl aspartate（NAA）,Choline（Cho）,creatine（Cr） peak area and calculated NAA/Cr and Cho/Cr ratio were obtained.Results No significant difference was observed between the PD and control groups for NAA/Cr and Cho/Cr in MO and SN.There was no obvious correlation between metabolite ratios（NAA/Cr and Cho/Cr） with clinical indexes in MO.For SN,NAA/Cr and Cho/Cr ratios in PD patients showed significant negative correlation with UPDRS score（r=-0.686,P=0.007;r=-0.770,P=0.002） and UPDRS motor score（r=-0.724,P=0.004;r=-0.843,P0.001）.The NAA/Cr,Cho/Cr ratio had significant negative correlation with HY classification（r=-0.697,-0.715,P=0.012,P=0.009） in SN.Conclusion 1H-MRS can not be used as a tool for early diagnosis of PD.Metabolites changes in unilateral substantia nigra can reflect the progress of PD.